P956: EMMY COHORT: MANAGEMENT OF NEWLY DIAGNOSED OR RELAPSED/ REFRACTORY MULTIPLE MYELOMA IN PATIENTS AGED OF 80 YEARS AND OVER
Authors: M. Macro, O. Decaux, A. Perrot, B. Royer, M. Chretien, K. Belhadj, M. Mohty, L. Frenzel, X. Leleu, M. Dib, O. Allangba, P. Zunic, I. Botoc, J. Malfuson, P. Moreau, R. Garlantazec, N. Texier, R. Germain, C. Deal, C. Hulin
Journal: HemaSphere (2022)

Background: Multiple myeloma (MM) patients aged 80 years and older are a population more prone to comorbidities, frailty, cognitive impairment or physical decline and require appropriate management of their myeloma. They are often underrepresented in pivotal clinical trials, with little data available on their management. The EMMY study is a large-scale epidemiological study to assess the epidemiology and real-life management of MM and can focus on the use and real-life efficacy of treatments for newly diagnosed or relapsed/ refractory elderly MM patients. Aims: To describe the management of MM in newly diagnosed or relapsed patients aged 80 years and over and to assess the real-life effectiveness of the treatments received. Methods: EMMY is a descriptive, multicenter, national, non-interventional study conducted in 72 IFM (Intergroupe Francophone du Myélome, sponsor) centers in France. Any patient initiating treatment for MM over a 3-month observation period, from October to December, is included, since 2017. It is a dynamic cohort with the inclusion of approximately 900 patients each year: 2765 patients included at the end of 2019 of which 561 were aged 80 and over (20.3%). Data are updated annually from hospital records up to 2020 at the time of the analysis. Four cohorts of patients aged 80 years and older were analysed according to the line of treatment initiated during their follow-up: L1, L2, L3 or L4+. Median time to next treatment (mTNT), median progression-free survival (mPFS) and median overall survival (mOS) were assessed in months(m). Results: Patients ≥80 years initiated 19.8% of L1s (237/1199) 22.7% (232/1022) of L2s, 22.2% (167/751) of L3s and 18.7% (288/1540) of L4+. They are 7.5% patients ≥85 years old to initiate L1, 8.7% L2, 7.4% L3 and 5.1% L4+. When the line is started, an ECOG ≥2 is reported for 39.4% of L1, 27.7% of L2, 35.1% of L3 and 38.5% of L4 patients and comorbidities recorded in 45.1% of L1, 39.6% of L2, 35.4% of L3 and 38.6% of L4+. In L1, the ISS is level I, II, III for 20.2%, 27.4% and 52.4% of patients. In L1, over the 2017-2020 study period, patients received treatment with PI (58.6%), IMID (32.1%), PI/IMID (4.2%), anti-CD38 (1.3%) or other molecules (3.8%). In L2, they received PI (22.8%), IMID (48.7%), PI/IMID (11.7%), anti-CD38 (14.2%) or other (2.6%), in L3 PI (12.6%), IMID (38, 9%), PI/IMID (9.6%), anti-CD38 (29.3%) or other (9.6%) and in L4+ a PI (23.3%), IMID (20.1%), PI/IMID (5.6%), anti-CD38 (29.2%) or other (21.9%). More than half received a double combination in L1 (50.2%), L2 (59.9%), L3 (54.4%) and L4+ (53.8%). Regarding efficacy, mTNT is 20.3m [15.2; 24.6] in L1, 14.7m [12.3; 20.4] in L2, 10.8m [9; 13.5] in L3 and 8.2m [6.5; 11.2] in L4+. The mPFS is 19.3m [15.1; 23.2] in L1, 12.6m [10.1; 17.5] in L2, 8.9m [10.1; 17.5] in L3 and 5.9m [4.5;7.4] in L4+. The mOS is not reached in L1 (rate at 30m: 76.7% [70; 83.3]) and L2 (rate at 30m: 58.1% [48.1; 68]; it is 25.7m [17.1; NE] in L3 and 18.3m [13.4; 22.4] in L4+. Summary/Conclusion: Patients ≥80 years of age account for more than 20% of de novo and relapsed myeloma patients treated in EMMY. Double combinations are used in half of the situations. Over the study period, PI-based treatments were preferred in L1, IMID-based in L2 and antiCD38 for 30% of patients in L3 and L4+. The benefits in terms of survival are real and this specific population is likely to increase significantly in the near future, requiring human and logistical resources.